Clubfoot
A neonate can have a varus position of the foot without this being pathological. The cause of this is usually a preferred intrauterine posture and the foot can therefore be passively rectified.
In terms of a pathological clubfoot, three components can be distinguished that can each occur separately or together:
- A stretched position of the ankle joint.
- A varus position of the rear foot.
- An adduction position of the forefoot.
In 80% of the cases, the aetiology is unknown, yet there appears to be a familial tendency. In 20% of the cases, this abnormality is associated with other abnormalities, usually neurological. Children with clubfeet should quickly be referred to the orthopaedic surgeon.
After immobilisation in a plaster for a period of 3 to 4 months, the need for surgical correction will be examined.
Metatarsus Adductus
The forefoot is adducted compared to the rest of the foot. The forefoot can passively be brought into the neutral position.
Metatarsus Varus
The forefoot is in adduction and supination. There is also a high longitudinal arch and a deep skin fold on the transition between the forefoot and rear foot. Every child with metatarsus varus should be referred immediately, because it is not possible to completely correct the foot passively.
Pes Varus
The forefoot is in adduction and supination, the rear foot is in the varus position. Dorsal flexion is fully possible. Without treatment, the child will walk on the lateral edge of the foot to an extreme extent.
Metatarsus Primus Varus
The first metatarsal bone is adducted with respect to the rest of the foot and there is considerable space between digits I and II. This condition does not require treatment, although some suggest it has a causal relationship with the development of a hallux valgus at a more advanced age.
Talipes Calcaneus And Congenital Vertical Talus
In the case of talipes calcaneus, the rear foot is in extreme dorsal flexion and slight valgus inclination. The sole of the foot is flat and the medial side of the head of the talus does not protrude. Talipes calcaneus that cannot be corrected must be immobilised in plaster.
Regarding congenital vertical talus, there is severe malformation of the root of the foot. The rear foot at the height of the ankle joint is in fixed equinus. The mid and forefoot are in dorsal flexion and abduction (due to luxation in Chopart’s joint) with respect to the rear foot. The sole of the foot is convex instead of concave and the medial part of the head of the talus is clearly palpable. As this is a rigid defect, accompanied by many neuromuscular abnormalities, surgical intervention is indicated.
Hollow Foot
Hollow foot is a foot defect in which the forefoot assumes a fixed equinus position with respect to the rear foot. In 75% of cases, this defect is associated with neuromuscular disorders. In the other 25% of cases, it concerns an idiopathic disorder with a familial tendency. The defect mostly does not develop until between the 5th and 10th year of life. It is believed that the cause lies in an imbalance between the intrinsic and the extrinsic musculature of the foot.
There are two types:
- The simple cavus foot. This is characterised by rigid equinus of both the medial and lateral foot shafts with respect to the rear foot, which results in a high instep with an excessively concave longitudinal arch. Pain may be indicated at the height of the medial arch. Hammer toes and claw toes are often secondary symptoms.
- Cavovarus foot. Only the medial foot shafts are in equinus, and a non-rigid varus position of the rear foot can develop as a secondary symptom. Soft tissue correction is recommended by means of releasing the plantar fascia if the condition causes significant symptoms.